00:00:00:23 - 00:00:30:17 Adam Hocking Welcome to The Rounds, a podcast of Marshfield Clinic Health System. I'm your host, Adam Hocking. The Rounds brings together medical experts to discuss fresh, fascinating and important topics from the world of health care. Sexual health is an important part of overall health, identity and human happiness. Yet the subject remains culturally taboo, even in traditional health care circles. Dr. Hajira Yasmin is working to change that stigma and empower women to own their sexuality through her women's intimacy clinic. 00:00:30:18 - 00:00:49:21 Adam Hocking Dr. Yasmin counsels women on a wide variety of issues from pain during sex to sexual health, issues relating to pregnancy, cancer and menopause. Listen as Dr. Yasmin discusses her work and shares why she is so passionate about empowering women. Dr. Hajira Yasmin, thank you for joining us on the podcast today. 00:00:50:01 - 00:00:52:10 Dr. Hajira Yasmin Thank you for having me and it's my pleasure. 00:00:53:01 - 00:01:13:03 Adam Hocking So I think we have a super interesting topic that maybe is a sort of a niche topic that folks may not know that that we provide the service. And I think it'll be interesting to shed some light on this topic. You are the medical director of the Women's Intimacy Clinic. Can you talk about what that clinic is and how you serve women through that clinic? 00:01:13:16 - 00:01:46:02 Dr. Hajira Yasmin Sure. We started this clinic for Mushroom Clinic Health Systems in June of 2018. And this was mainly to address the sexual health concerns in women, which I had seen for the last almost two decades of my career, going through women's life span and seeing that they do suffer and they have trouble dealing with their sexual health. So they would come up to me and talk to me, but I did not have a dedicated time or resources to really address this. 00:01:46:12 - 00:01:59:18 Dr. Hajira Yasmin So I kind of took myself for a special training for almost a year to learn more about human sexuality and decided to open this clinic last year, sometime in June 2018. 00:02:00:17 - 00:02:04:09 Adam Hocking Can you talk a little bit more about the training in your background and sort of how you got into this field? 00:02:04:11 - 00:02:32:16 Dr. Hajira Yasmin Sure. I've been a gynecologist. I'm an obstetrician and a gynecologist dealing the mainstream obstetrics and gynecology for almost 17 years. But then as a medical student and during residency of gynecology, we do not get enough exposure to sexual health or human sexuality. I mean, we may be getting like about seven or 8 hours of didactic lectures, but we don't really see sexual dysfunction. 00:02:32:16 - 00:02:55:07 Dr. Hajira Yasmin We don't really look at different sexual orientation and, you know, transgender health or anything like that during our training. So I kind of was a little hesitant in counseling people coming from this different routes. And I wondered myself to be a little bit more aware of what are the changes happening in today's world and how do I take care of the sexual health of women? 00:02:55:20 - 00:03:29:15 Dr. Hajira Yasmin So I enrolled myself in University of Michigan in Ann Arbor for a as a sexuality educator and as a counselor being a medical doctor. We are kind of not great in counseling and, you know, talking about at length as a counselor. So the course really exposed me to learn as to how do I listen to people's sexual problems, how do I counsel them, and how do I help them navigate through these problems with the different medical skills that I have? 00:03:29:23 - 00:03:53:15 Dr. Hajira Yasmin I mean, in terms of treating them and I can fix medical problems, but what as a medical doctor, that I figured mainly in my practice for 18 years, I was not paying attention to the psychosocial element of it. I'm always fixing person, you know, as a medical doctor, you try to fix problems. You don't really try to see what is the root cause of it. 00:03:53:22 - 00:04:09:07 Dr. Hajira Yasmin And a lot of it is it kind of intersects with their sexual concerns. So I kind of became a much more well-rounded person to tackle sexual health concerns with this training that I got in Michigan. 00:04:10:18 - 00:04:31:21 Adam Hocking I think your your personal background and why you were sort of drawn to this field is interesting. You've talked you and I have talked in the past about sort of two factors being a woman of color and being raised in a conservative background. Sure. How did those two factors kind of influence you to take the path that you did or kind of mold your opinions on this? 00:04:32:00 - 00:05:07:15 Dr. Hajira Yasmin Sure. Being a woman of color, like any other culture, I was raised, you know, in a very conservative fashion, receiving messages about different types of messages. What to do and what not to do about your sexuality. But then coming through medical school residency and having traveled almost like three different continents in the world, I realized I am seeing patients for 17 years and the changes that happen in a woman's body defies so many myths. 00:05:08:09 - 00:05:50:04 Dr. Hajira Yasmin It is really a lot of stigmatization is associated with sexuality. And the same thing it happened with my mom who went through menopause. It was a very difficult menopause. There was not enough education that was available for doctors and they could not really guide her and navigate her through the menopausal changes. And these two things, seeing people, my family, my patients suffer through different aspects of exploring their sexuality, changes during their lifespan made me think this is something that is more scientifically based, this is more beyond the culture, it's above the culture. 00:05:50:04 - 00:06:13:00 Dr. Hajira Yasmin And we need to base our treatments and also helping people with a little bit more compassion and to see like what is actually causing the problem, the root cause of the problem, rather than just they walk into my office and I say, okay, I'm going to give you a hormonal medication and this is going to cut it. So I think this is how I decided that I'm going to get into this field. 00:06:13:00 - 00:06:23:04 Dr. Hajira Yasmin I am going to learn more about it. I'm going to see the root cause of their issues and I'm going to pursue as a sexual medicine expert, along with my gynecology and obstetrics. 00:06:23:04 - 00:06:36:08 Adam Hocking And I know there's a wide swath of of women that you see every day and they come to you with many different issues or questions. But can you take us inside? What sort of an average day looks like, what your day to day work is like? Sure. 00:06:37:06 - 00:07:07:13 Dr. Hajira Yasmin I was doing the mainstream obstetrics till about four months ago. I was taking care of both pregnant moms and also gynecology, which is mainly to do with like menstrual bleeding, prolapse and urinary incontinence. And sexual health was kind of sprinkled in this gynecology and obstetrics. Women population like people would come to me and say, I have painful sex, I have vaginal dryness, I have like difficulty in climaxing, I have like difficulty in turning on. 00:07:07:13 - 00:07:28:09 Dr. Hajira Yasmin And I would say, okay, well, it will come to that, but let's take care of this issue. So recently, after starting this clinic and also in the last four months, I stopped doing pregnancy and childbirth. Not that I don't don't like it. It was just the time constraints and I could not do myself obstetrics and sexual health and gynecology. 00:07:28:09 - 00:07:56:09 Dr. Hajira Yasmin So right now my scheduled will ensure patients who come exclusively for sexual health concerns or they will come for general gynecology, which means they will come in for a vaginal discharge, they will come in for bleeding menstrual bleeding, they will come in for urinary leakage, or they'll come in for vaginal prolapse, or I have a whole span of women walking into my office anywhere between 18 years of age to 90 or hundreds. 00:07:57:13 - 00:08:19:22 Adam Hocking I think it's interesting because some of the some of the issues that you mentioned, whether it's vaginal dryness or something of that nature, is more physiological. And I wonder you mentioned the actual act of sex and having an orgasm, which might be more physiological plus mental. Is that accurate? And how do you kind of take that approach? 00:08:20:12 - 00:08:59:20 Dr. Hajira Yasmin I don't think it's completely one or the other. I really think there is an intersection of various things for that symptom to pop up in that woman, because it's not I mean, I wouldn't even call that as physiological because if I say physiological, it's something that you are dictating to the woman that she has to put up with it because it's a change in your body that happens in menopause or after childbirth or in a chronic illness like you're suffering with diabetes or chronic autoimmune disease or even during your breast cancer survivorship or in fact, any other cancer survivorship. 00:09:00:03 - 00:09:26:04 Dr. Hajira Yasmin These changes can happen in the vagina. It can happen in your vulva, which is the outer portion of your vagina. And these changes may not be physiological. They may be drug induced, they may be chemotherapy induced, or they may be just age changes related to your age. So I as a medical professional, I think I have to first find out if there is a medical reason that is causing this changes. 00:09:26:10 - 00:09:50:17 Dr. Hajira Yasmin And secondly, if there's any illness or any medication that they are taking that we are treating is resulting in this whole span of symptoms for them. And then I look at the other factors, like you said, is a psychological. Is it anything else that intersecting? Is it a social environment? Is it the stressors in their daily life or anything else that's aggravating this or causing this symptom? 00:09:51:23 - 00:10:18:11 Adam Hocking You know, I think it's interesting. You talked about your conservative upbringing. And we live in the in the Midwest, in central Wisconsin, which can be a more culturally conservative background. I wonder, given that context, do you find that women, especially maybe at first have difficulty talking about these issues? Is there is there work that you have to do to kind of get them comfortable to talk about these things or or do you not find that. 00:10:19:11 - 00:10:53:12 Dr. Hajira Yasmin That's a that's a great question. You know, I was thinking that I would have some resistance in this central rural Wisconsin when I opened this clinic a few months ago. But honestly, I think my approach to women and my rapport with them talking about their general gynecology or their general obstetric needs, like their pregnancy or or, you know, the imagine ideas or the pap smears or their mammogram, then I kind of dabble into their sexual health concerns and they are very open about it. 00:10:53:12 - 00:11:16:13 Dr. Hajira Yasmin I sometimes see a joy on their face when I ask them, How is your relationship going? Is everything okay in terms of your vaginal health? Can I ask you something more private? And people are like having relief on their face. Like, thank God she talked about this. And many of them have mentioned to me, you are the first doctor who's asking me this. 00:11:16:13 - 00:11:36:14 Dr. Hajira Yasmin And I have been suffering with this problem with painful sex for ten years or five years, and nobody has spoken to me. And they delve into it deeper and deeper, and then I get into that portion of it. I've never found a regret or remorse or a complete shut down. You know, I have not seen that in my practice. 00:11:36:14 - 00:11:54:02 Dr. Hajira Yasmin I mean, it is possible that it may be the way you approach or it may be because I'm a female gynecologist touching on these sensitive culturally sensitive topics. I don't see that hesitation in my practice. I feel like they are much more relieved to talk about it. 00:11:54:20 - 00:12:17:01 Adam Hocking I think it's really interesting that you mentioned, you know, a lot of women will say you're the you're the first doctor that's ever brought this up. And I you know, I kind of want to unpack that a little bit as to why part of my speculation and this is just speculation would be that maybe the general medical community thinks of sex and sexual health as almost a nice to have but not a need to have. 00:12:17:08 - 00:12:25:04 Adam Hocking And I think your perspective is much more sexual health is interwoven with overall health and and happiness. Can you maybe expound on that? A little bit? 00:12:25:05 - 00:12:52:16 Dr. Hajira Yasmin Absolutely. I totally believe sexual health is very integral to human health. I mean, if you have a good sexual health, it really increases your emotional satisfaction, your physical and your mental satisfaction to cope with any diseases that you have, any chronic disease, any cancer, or even your normal health, you know, you're much more approachable, you're happier. And it's and we are all sexual beings. 00:12:52:16 - 00:13:22:02 Dr. Hajira Yasmin I think we are wired as humans and sexual beings. So I feel as a medical doctor or even a medical provider, you really need to focus on sexual health and what you said, Adam is very right. There has been an era of medical care in our communities, either in central, rural Wisconsin or any other place. Doctors and medical providers failed to touch upon sexual health because of two reasons. 00:13:22:07 - 00:13:44:15 Dr. Hajira Yasmin One is that they may be thinking that the patient is not asking me or telling me about it. It's kind of a disconnect. They feel like the patient has no problems. That's why she's not discussing with me. And the patient may be expecting sitting in that office, Oh, I just wish my doctor or my medical provider will question me on that. 00:13:44:22 - 00:14:12:06 Dr. Hajira Yasmin So there is kind of a mutual disconnect. And the second reason is I feel there's not enough training and exposure and time constrained in a regular medical office setting. They don't have the time in 20 minutes or 30 minutes to talk about sexual health, to talk about dryness, to talk about painful sex, to talk about vaginismus or some skin condition on your vulva that's causing this issues. 00:14:12:11 - 00:14:33:13 Dr. Hajira Yasmin I mean, many medical providers may think she's here for a pap smear or she's here for diabetes, medication refill. I'm just going to look at that. I'm not going to get into other things because of my time. I have 30 minutes to see her. I'm not going to get into the other thing. So I think it's a time and resources constrained and also kind of a mutual disconnect. 00:14:33:20 - 00:14:59:02 Dr. Hajira Yasmin And my third thing is maybe a lack of training. You know, like there's no confidence and there may be some personal bias, too, because v v, as medical providers are human, we have our own personal sexual script. I call that we have our own script. We have we are raised in different surroundings. We may think, okay, it's a taboo, it's a hard topic. 00:14:59:02 - 00:15:24:15 Dr. Hajira Yasmin I'm not going to talk about this. It's not my culture or it's not my religion to talk about sex. So and that is perfectly okay for medical provider, but just make sure that you don't put that focus on your patient. Don't project your own focus on that patient. And that's my part of my my sexuality educator hat that I'm wearing. 00:15:24:22 - 00:15:38:23 Dr. Hajira Yasmin I try to tell every medical provider it's okay to have your own choices, but please give the patient dear choice to see another provider who is more sex positive and who can talk and help those people. 00:15:40:05 - 00:16:07:13 Adam Hocking I want to take an even bigger step back and talk about the term heteronormative and just what you were saying kind of got me to thinking, you know, I wonder if even an additional issue with, you know, providers being uncomfortable or reluctant to talk about this issue is, you know, if you look at the founding of of medicine and medical schools and institutions, those are very traditionally male dominated spaces. 00:16:08:07 - 00:16:18:11 Adam Hocking I think the Marshall Clinic didn't have their first female doctor until 1942. She learned that the other day. Do you think that that sort of institutional foundation has anything to. 00:16:18:11 - 00:16:38:23 Dr. Hajira Yasmin Do with it? It is. It is. It's very historical. You know, a female especially female sexuality. It is such a hard topic for people even to imbibe today. I mean, it is a complete change in your mindset in the way you tank. And I wouldn't call that as something bad, but it's just the way the culture we are raised in. 00:16:38:23 - 00:16:59:04 Dr. Hajira Yasmin And, you know, as you said, heteronormative is a default norm. I mean, that's the way we are raised. You are born as a male and a female. You are always heterosexual. You cannot there's that. There's a huge transphobia, there is a huge homophobia in our society and culture. And that's because that that is the way we are raised. 00:16:59:04 - 00:17:26:11 Dr. Hajira Yasmin Is it because of societal pressures, because of culture or because of religion and faith? These are the intersectionality that are intersect the sexuality of anybody. And I think that's a that's a big change. We are trying to change this paradigm of sexual health care. As you said, we are very privileged because I'm a cis gender, so I am a female and I pronounced myself as a female. 00:17:26:11 - 00:17:47:08 Dr. Hajira Yasmin But, you know, but there are so many other people that sometimes in medical setting, it is hard for us to even ask, what is your pronoun? What do you want to be identified as? So we take them for granted that they are heteronormative or heterosexuals and DCIS genders, which means, yes, she's a female because she was born as a female sex at birth. 00:17:47:08 - 00:18:11:21 Dr. Hajira Yasmin And yes, this is a male because he was born as a male at birth. So it's a complete change in your mindset. And I think we are a very privileged class because we are like a majority of them in this world are heteronormative, are heterosexual. So that classifies the remaining as a very marginalized population, which is that transsexuals are transgenders and homosexuals. 00:18:12:16 - 00:18:22:06 Adam Hocking Do you find for those folks in the LGBTQ community that it's even harder for them to come forward and talk about sexual health issues? 00:18:22:10 - 00:18:52:04 Dr. Hajira Yasmin Absolutely. I was not very much aware before my Michigan course about the health challenges that this sexual minority deals with. I had the opportunity to meet these people. I actually met many of my transgender patients, homosexual patients that they have fear of getting into medical communities and medical settings like offices, urgent care, emergency rooms to really seek medical help. 00:18:52:11 - 00:19:15:01 Dr. Hajira Yasmin And then with me doing this course and being more aware of their medical needs, I think what has got out and my community where I practice and I actually first have started seeing some of the trans folks who have walked into my office and I'm happy about that, that I do take care. I'm not at a stage to really decide whether it's right or wrong. 00:19:15:06 - 00:19:19:18 Dr. Hajira Yasmin As a medical doctor, I think it's my job to take care of the medical needs. 00:19:20:00 - 00:19:43:05 Adam Hocking I know one of the things that your work is focused on and that you're passionate about is women that are menopausal or post-menopausal. And I remember you saying to me prior to the interview that there's a again, a cultural or a societal bias where women reach a certain age and it's almost like we write them off from a sexual perspective. 00:19:43:05 - 00:19:54:22 Adam Hocking Like, again, it would be a nice to have, but I don't need to have or they've gotten to a point where they don't want sex anymore. And I know that that's that's not the case and that's something that you're passionate about. Can you talk about. Sure. Issue. 00:19:54:23 - 00:20:34:03 Dr. Hajira Yasmin Sure. That's a big aspect. In my clinic, Adam, because this is something that I am striving hard to change in my gynecology practice because majority of my patients, if I don't deal with pregnancy, are between the ages of 40 to 90. And this is a transition that happens between what we call is perimenopause and menopause. And they start experiencing problems like hot flashes, night sweats, vaginal dryness, painful sex, and all of these, I don't think we are educating our women regarding this change that is going to happen after childbirth. 00:20:34:10 - 00:20:55:04 Dr. Hajira Yasmin We are just telling them we are hearing about menopause from our mothers, our grandmothers, who are just going to say there's a change that's going to happen to you when you're 50 or 45, but there is no one on one class about it, like how pubertal changes are told to our daughters. We tell them, okay, these are the anatomy changes happening in your body. 00:20:55:10 - 00:21:15:01 Dr. Hajira Yasmin You should be prepared for your first menses. You're going to have pubic hair. Come on, axillary hair. Come on. But we don't prepare women for menopausal change. Again, that is a big shift because if we prepare them, they're able to cope with that better. They are able to come and seek for help. They are able to come and say, Yes, I have dryness. 00:21:15:01 - 00:21:42:09 Dr. Hajira Yasmin I like. I see patients pretty much every day who are menopausal, who walk into my office with multitude of symptoms that I am seeing. So I'm in the process of educating women and I have trying to arrange some women's seminars here to begin with in Wausau from Marshall Clinic Health Systems, because it's menopause, can not just impact sexual health, it can impact your breast health, your bone health. 00:21:42:15 - 00:22:06:20 Dr. Hajira Yasmin And how do we protect these women from all aspects and help them lead a good menopausal health? Because, you know, in 1900, women used to die a few years around menopause. They used to have kids, procreation, have kids. Okay, maybe a couple, maybe ten years, 20 years, and they are dead. But now half of your life is spent in menopause because. 00:22:06:20 - 00:22:37:14 Dr. Hajira Yasmin Okay, average age of menopause in our country here is about 51. But some of them go into menopause at 45. Some of them don't go into menopause till 55 or 60. They will just be having very irregular periods or menstrual periods with all symptoms of menopause like hot flushes, night sweats, pain in the vaginal area, vulvar area, a vaginal discharge, and a lot of other conditions that we just are not prepared to take care of it again, due to multiple reasons that I quoted before. 00:22:38:09 - 00:22:54:23 Adam Hocking Do you find that a large part of your role in seeing women or patients of of across the spectrum is education and just talking about these issues? Do you feel the need to fill that education gap or point folks to those resources? 00:22:55:11 - 00:23:29:03 Dr. Hajira Yasmin I think it's a huge amount of education, which is at least about 40 to 50% is education, and the remaining is medical therapy. And medical therapy could be hormones. It could be something that you're trying to restore those tissues that were not taken care of for ten years, 20 years back to normal. Sometimes I get patients in such conditions who are like in seventies and eighties, they have not taken care of the vulvas and vaginas and they can't even function. 00:23:29:03 - 00:23:59:08 Dr. Hajira Yasmin Forget about sexual health. I mean, they can be functioning sexually, but they can't even walk without pain. They can't sit without pain because they didn't take care of it. So it's education and medical therapies, you know, So I have to it's not like one size fits all. I have to go through a very detailed history with them, do an exam, and then decide what suits their need to make them comfortable and functional in all aspects. 00:24:00:16 - 00:24:03:19 Adam Hocking It's almost like a whole area of the body is being sort of. 00:24:03:19 - 00:24:28:04 Dr. Hajira Yasmin Yes, it's a very holistic approach, I would say. I call this as a very holistic approach. Like I had somebody who is 22 years old and somebody said she has painful sex and they just put her in my women's intimacy clinic. And my Miami, who was grooming the patient, came and told me she's a 22 year old who has this pain with sexual intercourse. 00:24:28:04 - 00:24:54:09 Dr. Hajira Yasmin And I am like, huh, 22 and painful sex. I mean, that kind of raised a red flag in my mind because 22 is the prime age of your fertility or reproduction. And you know, all your organs are to be functioning optimally. And how could you have pain? I mean, she's not the first one. I've seen many people and she had met a couple other medical providers and had no help there. 00:24:54:09 - 00:25:21:03 Dr. Hajira Yasmin So she had she was referred to my clinic. So when I went in to see her, there are a lot of issues which are psychological, social, that is intersecting with medical issues in her local vaginal and vulva area. And somebody had not looked on the outside and of her vulva and the vagina and they were all focusing on the uterus and the ovaries and the menstrual bleeding. 00:25:21:21 - 00:25:44:09 Dr. Hajira Yasmin And we forgot about the other three pieces that she lives in as a human body. She's got the outer skin, she's got the labia and all of that. And then she's also got a psychological piece to it. She's got other things which nobody inquired. So I think we as medical providers, we have to treat the person as a whole. 00:25:44:09 - 00:26:07:21 Dr. Hajira Yasmin BE It is a very holistic approach and only then you will get to the root of the problem. Otherwise you just going to keep keep giving medications. We are going to apply some Band-Aids. She'll find some relief for a few days, then she'll jump into another provider, another provider, and that's how many patients go through the whole system, seeing at least ten providers because we are not figuring out what is the root cause of this problem. 00:26:08:13 - 00:26:17:15 Adam Hocking It's fascinating. You work specifically with women who are going through cancer or are recovering from cancer. Can you can you talk about. 00:26:17:23 - 00:26:42:09 Dr. Hajira Yasmin Should that work? Yeah, Yeah, I know I have actually, I started this work mainly with cancer survivors and a long time ago in my office, even when I was doing the routine obstetrics there and got oncology for the last couple of years, because these patients, cancer survivors, sometimes with the genetic mutations, they were referred to me to have their ovaries removed because they have breast cancer. 00:26:42:09 - 00:27:06:14 Dr. Hajira Yasmin And then I would take out the ovaries because I do surgery too, and they would come back to me to say, Oh, now I can have sex. It's very painful. And, you know, they lost your hormones and they are on anti estrogen medications, They are on chemotherapy. And I would face more sexual health concerns from my cancer survivors in my routine practice of last two decades. 00:27:06:14 - 00:27:34:19 Dr. Hajira Yasmin And that's when piqued my interest and said, okay, this is something that's really frequently happening in these women. We need to look into this. Why is this so frequent? And she's only 35 years old or 45 years old, and she has to suffer with this kind of intimate physical concerns. So that why I started working more now with cancer survivors and I do talks for cancer survivorship meeting more recently. 00:27:34:19 - 00:28:01:14 Dr. Hajira Yasmin I was in Monaco like a few weeks ago talking to 55 cancer survivors, and at least 10 to 15 of them came and told me there was no physician who came up and spoke to us about sexual health during our cancer journey 20 years ago, 25 years ago. Thank you for doing this. And so I think there want to be heard. 00:28:01:23 - 00:28:24:10 Dr. Hajira Yasmin Do they want this? They want to own their sexuality. They want to take care of it. They are surviving. They are survivors. They are battling cancer. They have come through cancer with success because they are cancer free. They are completed. Their medications, like their chemo is the radiation and all of that. They are surviving. We give them a long life. 00:28:24:17 - 00:28:57:07 Dr. Hajira Yasmin Well, we need to improve the quality. We need to talk to them about the relationships. We can't just tell them we improved your life span. Well, we broke your relationship. So I think that piece of sexual health is so critical for somebody who has cancer, any type of cancer, or even any chronic illness, any chronic pain syndromes like fibromyalgia, any any like diabetes or epilepsy or any any anything that intersects your normal health and is impacting your sexuality. 00:28:57:15 - 00:29:00:00 Dr. Hajira Yasmin I have a real passion to take care of these women. 00:29:01:10 - 00:29:20:09 Adam Hocking I'm curious your thoughts on sort of how we how we sort of puncture the status quo that we have right now, whether it's, you know, the average physician maybe not being comfortable talking about it or sort of the heteronormative, rigid sort of worldview that we tend to take as a culture. Obviously, it's not a we just do it. 00:29:20:09 - 00:29:20:22 Adam Hocking You know, it's a. 00:29:21:02 - 00:29:22:17 Dr. Hajira Yasmin Shock to people. 00:29:22:17 - 00:29:24:22 Adam Hocking And it's a process. But I'm interested. Your thoughts on that? 00:29:25:04 - 00:29:53:21 Dr. Hajira Yasmin Yeah, we are trying to create some education tool sessions. So I have given lectures and oncology departments here in Warsaw, in Boston, and I have also gone to Marshfield to cancer survivors meeting to bring about a change. I think it's a main thing is education. Education is a big piece of this because the communication about the resources that are available for these cancer survivors or anybody with diseases or illnesses or anything is critical. 00:29:54:03 - 00:30:35:18 Dr. Hajira Yasmin So we try to educate our other mid-level providers to say, yes, you can help them. And I came up with a little acronym for how to take a history on somebody who is suffering with sexual health concern that you suspect in your office, but you are not very confident to tackle it. You can. I came up with this model saying, PLISST P-L-I-S-S-T, and some of the psychologists use that like you could just use a little permission to say, Can I ask you something very private and then give them or is everything okay with you sexually, with your partner or with your boyfriend or anybody that you are engaging your sexual pleasures 00:30:35:18 - 00:30:57:13 Dr. Hajira Yasmin with? And they say yes. Then we don't have to worry about it. They say no. Then we kind of say, Can I help you on that? And they say, Yeah, I have vaginal dryness or I have pain. And then you just give them a very brief suggestion to say, okay, I'm going to recommend these lubricants for you. You can use this and come back and let us know when you come for your oncology appointment and for weeks. 00:30:57:20 - 00:31:19:06 Dr. Hajira Yasmin And if they come back and say it's not helping us, you know, it kind of made a difference initially or it never made a difference, then I encourage those people to say, please see somebody who has sexual medicine expertise as a consult so that you can meet this person and then you can come back to us for your follow up care. 00:31:19:06 - 00:31:43:18 Dr. Hajira Yasmin So I think to navigate that referrals and to give this limited information and be a little bit more open and confident in approaching these people is a big thing in this, you know, and also to educate our own medical providers, mid-level providers and to go to offices like I have another couple presentations that I'm supposed to do next month and the following month. 00:31:43:18 - 00:32:06:12 Dr. Hajira Yasmin And we do it in different systems, too, not just in Marshall Clinic Health System. I just got a recent invitation in another system across the town for me to come and speak to the a cancer survivor oncology meeting to say, what do we have to offer and how can we navigate those patient from a different system into our system to just see them and help them? 00:32:06:16 - 00:32:12:13 Dr. Hajira Yasmin I think there's a huge need. There's a huge need for sexual health in these people. 00:32:13:15 - 00:32:19:18 Adam Hocking Can you talk about the nature of your work with women that are trying to become pregnant, are pregnant or postpartum? 00:32:20:02 - 00:32:49:08 Dr. Hajira Yasmin Sure, sure. I mean, that's another interesting part that there are as an obstetrician and gynecologist. I think there are a lot of physicians who are doing amazing, amazing work during pregnancy. And we are taking care of these women. We are delivering them. We take care of them for nine months before pregnancy there. If they suffer with infertility issues or fertility problems, you know, we we touch up on sexual health at that time because we are trying to get pregnant. 00:32:49:17 - 00:33:13:21 Dr. Hajira Yasmin But once they are pregnant and have their babies, I think sexual health again takes a backstage because we become mothers, we become caretakers and nurturers. So the mom is focused on the baby and the doctor is focused on that relationship between the mom and the baby we forget about how's your vaginal health? How's your health with your partner? 00:33:13:21 - 00:33:38:22 Dr. Hajira Yasmin Are you able to resume sexual intercourse? Do you have pain from the scar that you had with your delivery? I think those are the questions that sometimes are lacking in in primary care offices and OBGYN offices and family practice offices. Again, it's education. And I am seeing people in my office who are coming after delivery, after fertility treatment. 00:33:39:01 - 00:34:05:08 Dr. Hajira Yasmin They're not able to get back and achieve their normal physical intimacy that they had before pregnancy. So it is a big problem. And can it be hormonal because the nursing. Yes. Can it be something psychological? Yes. Can it be a scar tissue or a spasm of the muscle that has developed because pushing out a £7 baby or a 9 to £10 baby through a vaginal opening will leave some impact there. 00:34:05:17 - 00:34:33:19 Dr. Hajira Yasmin You know, there will be laxity of your pelvic floor muscles. There can be spasm of your muscle. There could be scarring of the muscle, I think, to examine that woman with that aspect and really take care of the issue if it is present, is going to do a big difference for that woman's sexual health. I think we need to work as medical providers to restore sexuality in these women who are young and who have given birth to babies. 00:34:33:19 - 00:34:48:06 Adam Hocking Can you talk about the role of the partner women, sexual partner in supporting them, what role they can play in supporting them? If women are experiencing some of these issues that we've talked about and whether or not and how you incorporate the partner in your work? 00:34:48:11 - 00:35:10:02 Dr. Hajira Yasmin Sure. It's a great question, Adam. You know, this is another challenge that we as providers are going to face because I see women day in and day out who will listen to you and tell you I do understand what you're telling me, Dr. Yasmin, but you know, my partner doesn't understand this. Are you okay to talk to my partner? 00:35:10:02 - 00:35:33:09 Dr. Hajira Yasmin And I am more than happy. I sometimes like the partner to be there during the consultation so that they can hear. But it doesn't happen to a gynecology office. Typically, women come on their own, and very rarely the partner companies, unless the woman is pregnant and they want to take part in the happy part of the life. But when there is menopause or when there is sexual dysfunction, most of my patients, they walk in alone. 00:35:33:16 - 00:35:56:20 Dr. Hajira Yasmin But they do express a saying, you know, I have told him, but I think it would be good if you can talk to my husband or my boyfriend or my partner. Communication is very, very important. We as women, we fail to communicate. I say, before sex during sex and after sex, we don't communicate because you don't tell. This is hurting you. 00:35:56:21 - 00:36:21:23 Dr. Hajira Yasmin You don't say. You really don't enjoy that. I hear all the time where the patient tells me I just put up with this sexual activity because I don't want him to stray. I do not enjoy this at all. I said, Did you tell him that? No. Yeah, you got to because you got to own your sexuality. If you don't own and you don't communicate, it's never going to be fixed. 00:36:22:21 - 00:36:50:23 Dr. Hajira Yasmin I can sit here for 40 minutes with you and tell you everything that's available for treatment. But if you don't communicate that after cancer treatment, your vagina has changed, your vulva has changed your breast. After mastectomy for breast cancer, you don't like to be touched. There. After mastectomy, you need to communicate. So communication is very integral for sexual health, especially you communicate to your patients and patients communicate to their partners. 00:36:51:03 - 00:37:00:01 Dr. Hajira Yasmin And that has to be communication all the time. I tell them you got to communicate before sex, during sex, after sex. That's my mantra for them to be happy. 00:37:01:16 - 00:37:04:01 Adam Hocking What have you learned about people in doing this work? 00:37:05:10 - 00:37:30:05 Dr. Hajira Yasmin I have learned a lot. And it is it is a very gratifying experience that I have had in the last two years. I have learned that there is so much to women's health. And I, as a medical provider, as I told you, I was trying to fix abnormal. You try and bleeding with hysterectomy. I was trying to treat urinary incontinence by doing surgery. 00:37:30:12 - 00:37:57:20 Dr. Hajira Yasmin I was doing medication treatment. But then I learned there's so much pain, there's so much sadness and hurt that's associated with sexual health, with menopause, with childbirth, with chronic illness that we see those patients just for 3 minutes, 40 minutes max, about 60 minutes. But there are root cause for what we are seeing in our office. So I think I have learned a big lesson in my life. 00:37:58:01 - 00:38:21:20 Dr. Hajira Yasmin You can't just treat the vaginas. You can't just treat one piece of a human body. You got to get to the bottom of everything. Then you will be able to fix things. And it's it's a very holistic way of looking at life and medical issues. So I think that has opened up my eyes to say, yes, if somebody walks, anyone with urinary incontinence of it's abnormal bleeding. 00:38:22:04 - 00:38:30:20 Dr. Hajira Yasmin I somehow circled back to why this whole issue has happened and what impact it has on that woman's sexual health. 00:38:32:15 - 00:38:51:07 Adam Hocking So I think your passion for this field is is obvious and it's infectious. And we talked a little bit about your background and how that kind of shaped you and going this direction. But can you talk, I guess, just to kind of bring things full circle about why you're so passionate about this work? 00:38:52:11 - 00:39:17:07 Dr. Hajira Yasmin Yeah, I mean, I, I would say I would come back to the same things saying I would a being a gynecologist. I'm always going to be seeing women in my office still I'm alive or retired. You know, I really want empower women. My mission is to empower women, not make them go through their changes in their normal sexuality and suffer in silence. 00:39:17:07 - 00:39:48:21 Dr. Hajira Yasmin I think we are not a good we are not good communicators. We don't talk. We always take care of people around us. We are nurturers, as I told you, but we don't was an experienced pleasure. Historically, experiencing pleasure for a woman was perceived as selfish and self-centered, and I'm trying to change that. It's okay for you to experience pleasure, be it a sexual pleasure, or beat a normal pleasure going for a cup of coffee. 00:39:48:21 - 00:40:20:01 Dr. Hajira Yasmin It's okay. It's okay for you to leave your kids home and go out and experience pleasure. I think I want to be the wise of women because I'm a women's medical doctor, so that's my passion. Till I'm alive, I think I want to people not to feel judgmental, not to feel very about their sexual health concerns. I want to give them that power, the voice to really own their sexuality and even explore it because the sexuality is not going to be as a gift till you're alive. 00:40:20:01 - 00:40:41:07 Dr. Hajira Yasmin It's going to change and it's going to go away from you. You're going to lose a lot of things as you age. I would want women to be empowered and say this is a change that's coming. I want to be prepared and I want to take away the pain, the isolation, the unhappiness. Because if I make the woman happy in the house, everybody's happy. 00:40:41:19 - 00:41:02:00 Dr. Hajira Yasmin The world is happy, Right? It's, you know, and I feel like if a woman's sexual health is good when she comes back in six weeks to see me, she's a different woman. And that gives me a whole amount of satisfaction and says, okay, so her world is happy, her husband is happy, her boyfriend is happy, her children are happy. 00:41:02:05 - 00:41:38:08 Dr. Hajira Yasmin So I think to create a happy world, to make women happy and lead a nice, functional life that beats sexual or non-sexual, to be physically and emotionally connected to their partners and be lead a happy life. That's going to be a tremendous gift for me. So I think that's my goal till I practice for how many every number of years I have remaining, I mean, maybe another two decades to just kind of infect more people with my passion and also to educate more women and market providers to do the same thing that I'm doing. 00:41:38:20 - 00:41:43:13 Adam Hocking So, Dr. Yasmin, thank you so much for joining us today. It was fascinating and it was a pleasure to have you here. 00:41:44:02 - 00:41:49:00 Dr. Hajira Yasmin Thank you, Adam. It was my pleasure to be here and share my thoughts with you. Thank you so much. 00:41:49:07 - 00:42:15:00 Adam Hocking The Rounds is produced by the Marketing and Communications department of Marshfield Clinic Health System. You can subscribe to The Rounds and download episodes via iTunes or by visiting Shine365.MarshfieldClinic.org. I'm Adam Hocking and I hope you'll join us next time on The Rounds.